**2. Before the beginning**

### **2.1 When you don't know, it's no!!**

This point of the chapter is essential given that a large number, not to mention all, of the patients with systemic lupus erythematosus (SLE) are of childbearing age and previously aware of the hormonal effect on which the disease is active. It is very important that the type of treatment received by the patients is also taken into account since several medications have a teratogenic component [1].

#### *2.1.1 There is desire we don't know it's*

Patients with SLE should, as far as possible (and in an ideal world of course), receive clear, precise and, above all, timely advice on contraception, the effect of the medication on the product, and its suspension in the event of an unplanned pregnancy. And why not say it, the possible outcomes in the absence of strict control and clear communication in the relationship between the doctor and the patient, to reduce complications, answer questions, and clear up any doubts that arise at the time. This must always go hand in hand individually with each of the patients since each one of them is a "world apart." Always taking into account the risk of each one not only due to the existing disease but also due to others that add up to further complicate the picture [3]. With this we can address, apart from SLE, chronic degenerative diseases together, such as high blood pressure, obesity, smoking, and in some other patients ask about existing family history of cancer that is hormone dependent. Together with SLE, the association with antiphospholipid antibody syndrome (APL) must be sought insistently, since this leads to an increased thrombotic risk.

The planning of the pregnancy by the multidisciplinary medical team and the patient increases the probability of a successful outcome and is a vital strategy to reduce perinatal morbidity and mortality complications, recognize them if they occur and make an "itinerary" with stations in which the patient knows how to deal with each of them always hand in hand with the medical team [4]. When preconception counseling begins, the main complications that could arise in pregnancy should be explained in detail, slowly and with the greatest simplicity, but without losing the meaning of the counseling.
